UNIT 9: COMMON EAR, NOSE AND THROAT PROBLEMS



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AMREF DIRECTORATE OF LEARNING SYSTEMS

DISTANCE EDUCATION COURSES

Unit 13:

Common Ear, Nose and Throat Conditions

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UNIT 13: COMMON EAR, NOSE AND THROAT CONDITIONS

A distance learning course of the Directorate of Learning Systems (AMREF)

© 2007 African Medical Research Foundation (AMREF)

This work is distributed under the Creative Common Attribution-Share Alike 3.0 license. Any part of this unit including the illustrations may be copied, reproduced or adapted to meet the needs of local health workers, for teaching purposes, provided proper citation is accorded AMREF. If you alter, transform, or build upon this work, you may distribute the resulting work only under the same, similar or a compatible license. AMREF would be grateful to learn how you are using this course and welcomes constructive comments and suggestions. Please address any correspondence to:

The African Medical and Research Foundation (AMREF)

Directorate of Learning Systems

P O Box 27691 – 00506, Nairobi, Kenya

Tel: +254 (20) 6993000

Fax: +254 (20) 609518

Email: amreftraining@

Website:

Writer: Prof. Rachel Musoke

Cover Design: Bruce Kynes

Technical Co-ordinator: Joan Mutero

The African Medical Research Foundation (AMREF wishes to acknowledge the contributions of the Commonwealth of Learning (COL) and the Allan and Nesta Ferguson Trust whose financial assistance made the development of this course possible.

UNIT 13: COMMON EAR, NOSE AND THROAT CONDITIONS

INTRODUCTION

Welcome to this Unit on common Ear, Nose and Throat (ENT) problems. As you may recall, in Unit 12 you learnt that some of the acute respiratory infections such as acute otitis media would be discussed in this Unit. ENT problem are very common among children. Indeed, more than 80% of the children will have experienced an ear infection, blocked nose or sore throat by the age of three.

There are many diseases of the ENT, but in this unit we shall limit ourselves to the common ones which affect children. These are

• Ear infections

• Sore throat

• Blocked nose or nasal discharge

• Sinusitis

• Allergic Rhinitis

LEARNING OBJECTIVES

By the end of this unit you should be able to:

• List the common conditions that affect the ear, nose and throat;

• Describe the causes of common ENT conditions;

• Describe the presentation of each of the common ENT conditions;

• Manage appropriately the common ENT conditions;

• Prevent each of the common ENT conditions.

We shall start our discussion with conditions that affect the ear.

13.1: EAR INFECTIONS

In this section, we shall discuss how to assess, classify and treat a child with an ear infection. How well do you remember the anatomy of the ear? Start by reviewing the following diagram of the ear in Figure 13.1.

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Figure 13.1: Anatomy of the ear

As you well know, the ear is part of the respiratory tract. From figure 13.1 you can see that it is connected to the nose and throat by the Eustachian tube. That is why an infection that starts in the throat can easily spread to the middle ear and cause an ear infection..

What is an acute ear infection?

An acute ear infection is an infection of the middle ear which lasts for 14 days or less. A chronic ear infection lasts for more than 14 days. Infection in the middle ear is also known as otitis media.

What are the causes of ear infection?

The ears can become infected when there is an infection of the nose or throat. The same micro organisms that cause infection in the nose or throat are also the ones that cause infection of the ear. The bacteria most commonly responsible are Streptococcus pneumoniae and Haemophilus influenzae.

Signs and symptoms of ear problems:

A child with an ear problem has some or all of the following signs and symptoms:

• Pain

• Fever

• Pus discharge from the ears

The dangers of ear infection:

Infections of the ear rarely cause death. However, they can cause many days of sickness in children. If an ear infection is not identified and treated early, it can put the child in danger of the following:

• Infection of the mastoid bone behind the ear called mastoiditis;

• Meningitis or encephalitis (infection of the brain);

• Deafness;

• Developmental and learning problems.

To diagnose an ear infection, you must assess the child correctly and follow the steps below:

STEP ONE: ASSESS THE CHILD

Assess the child by asking the mother the following questions:

• Does the child have ear pain? Ear pain may mean an infection

• Does the child have pus draining from the ear? If so, for how long?

Pus draining from the ear is a sign of infection even if the child no longer has pain.

b. Look and Feel

• Inspect the pinna for any boils or sores;

• Pull the ear gently in all directions. If this causes pain, then that is a clue that the infection is probably in the outer ear;

• Look for pus draining from the ear or for a red immobile eardrum (you can use an otoscope if you have one);

• Look to see if a foreign object is in the ear;

• Feel for tender swelling behind the ear;

• In young infants, the swelling may be above the ear.

c. Examine the ear:

To examine the ear, the patient is placed correctly on the mother’s lap. The child is secured firmly by the mother holding the child’s hands with one hand and his head with her other hand. See Figure 13.2a.

If you have an assistant, he/she can help you to hold the child’s head. You should sit at the side of the patient with your eyes at the same level as the child’s ears (the organ to be examined). The distance is usually 30cm from the patients head. The hand holding the otoscope is placed on the child’s head. Should the child move the head, the otoscope moves with the head, thus avoiding perforating an inflamed tympanic membrane.

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Figure 13.2 (a) Mother holding a child for otoscopy (b) A healthworker examining the ear

|ASSESS |

|ASK |

|Does the child have ear pain? |

|Does the child have pus draining from the ear? |

|If so, for how long? |

| |

|LOOK and FEEL |

|Look for pus draining from the ear or for a red, immobile ear drum |

|Feel for tender swelling behind the ear. |

STEP TWO: CLASSIFY THE ILLNESS AND TREAT IT:

You need to classify a child with an ear problem as having one of the following:

• Acute ear infection (Acute otitis media)

• Mastoiditis

• Chronic ear infection

Let us now discuss how you should manage each of these conditions:

1) Acute ear infection:

A child who has pus draining from the ear for less than two weeks, ear pain, or a red immobile ear drum (seen by otoscopy) is classified as having an Acute Ear Infection, commonly known as acute otitis media. If you find a foreign object lodged in the ear, refer the child to a hospital for removal of the object.

Management of a child with acute ear infection.

Acute ear infection is managed by:

• Relieving pain with analgesics such as Paracetamol;

• Giving the child an antibiotic to treat the acute ear infection;

• Drying the ear by mopping if pus is draining from the ear (ear wicking);

• Giving the patient a nasal decongestant, such as 3-4 drops of epinephrine since a blocked Eustachian tube often cause otitis media. A decongestant helps in opening the Eustachian tubes if they are blocked.

• Following-up the patient daily after starting the treatment and referring the patient to the hospital if there is no improvement in the condition. In some rural areas this may be a problem. In that case, the patient is seen as frequently as possible until the signs and symptoms have cleared.

• Seeing a patient who is improving again after a few days in order to check for the very serious complications of otitis media.

The child with acute otitis media may have mild hearing loss that will probably last for some time after healing. If the child is in school, the teacher should be informed about this temporary hearing loss.

Once the infection has healed, you should ask the patient to come back in about 2-3 months. At this visit, you should do a hearing test. If there is any loss of hearing, you should refer the patient to a doctor.

2. Mastoiditis

This is an infection of the air cavities in the mastoid bone. Mastoiditis results from the spread of the infection from the middle ear. If the patient feels pain when you press or tap on the mastoid bone, then you should assume that the infection has spread to the mastoid cavities. Therefore, a child who has tender swelling behind the ear (in infants, the swelling may be above the ear) is classified as having mastoiditis.

Management of a child with mastoiditis in your health facility.

A child with mastoiditis needs antibiotic treatment and may require surgery. The child is URGENTLY referred to the hospital after a first dose of antibiotics (see Table 9.1.)

Table 13.1: Oral Antibiotics for Ear Infections

| TREATMENT OF AN EAR INFECTION WITH ORAL ANTIBIOTICS |

| |

|Give first dose of antibiotic in clinic. |

|Instruct the mother on how to give the antibiotic for seven days at home |

| |COTRIMOXAZOLE |AMOXYCILLIN |AMPICILLIN |

| |Trimethopim + sulphamethoxazole |*3 times daily for 7 days |*4 times daily for 7 days 75 mg / |

| |*2 times daily for 7 days |40 mg / kg / day |kg / day |

| |8 mg TMP + 40 mg SMX per kg per day | | |

|Age or Weight | | | |

| |Adult tablet |Paediatric |Syrup |Capsules 250 |Syrup |Tablets |Syrup |

| |Single strength |tablet |(40 mg TMP+ 200 mg|mg |125 mg in 5ml |250 mg. |250 mg in 5ml |

| |(80 mg TMP+ 400 |(20 mg. TMP + |SMX per 5ml) | | | | |

| |mg SMX |100 mg SMX) | | | | | |

| ................
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